| NPI | 1023226420 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ENRIQUE COLLANTES STA ANA President 304-757-8683 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 11628) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2020-08-22 |